What’s Your Patient Navigation Strategy?

December 11, 2014
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Patient navigation has become the new favorite strategy for healthcare organizations trying to overcome the challenges of a fragmented care continuum. Whether seeking control over a complete episode in a bundled payment, or trying to make connections within an ACO, navigators are fast becoming critical liaisons between the different settings and silos (like physician offices and post-acute providers) within a system of care.

Patient navigation has become the new favorite strategy for healthcare organizations trying to overcome the challenges of a fragmented care continuum. Whether seeking control over a complete episode in a bundled payment, or trying to make connections within an ACO, navigators are fast becoming critical liaisons between the different settings and silos (like physician offices and post-acute providers) within a system of care. Indeed.com’s job trends tool shows how much the title in job listings has grown over the last 7 years.

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Nurse Navigators are widely used and now showing benefits in multiple areas of the healthcare system beyond oncology, from colonoscopy scheduling to chronic diseases and can go by many names, including Patient Care Coordinators, Clinical Coordinators, or Health Coaches. They are also fast becoming an integral part of population health efforts.

These nurses are dedicated to navigating patients through their procedures and across the episode of care, making sure patients are properly prepared for surgeries or treatments, and helping them be compliant with their discharge instructions and follow-up care to avoid preventable readmissions. They act as a single resource for patients to call when they have questions or concerns and they coordinate transitions between the doctor’s office and the hospital, as well as rehab and home care providers. Their job is a mix of patient educator, scheduler, and case manager.

In my estimation, there is no other industry sector that has the degree of complexity and fragmentation of service delivery that healthcare does. Consider this comparison… In a transaction to buy cable TV there are only two parties: The consumer and the provider. Products are bundled and easy to understand and buy. Service delivery is relatively uncomplicated (provided you can wait patiently at home).

Now consider a large purchase like a home. For most people that goes to a three-party transaction: the seller, the bank and the consumer. The transaction is a bit more complicated and can benefit from assistance, so a real estate agent is often brought in to help navigate all the steps in the process.

Finally, consider a healthcare purchase like a joint replacement surgery. Here you might have a half a dozen parties to the transaction and dozens of steps to navigate across them.

  1. Payer/Employer/Insurance
  2. Surgeon/Clinic
  3. Hospital
  4. Rehab/PT
  5. Post acute care facility
  6. Home care services

Most consumers have neither the knowledge to understand the complexities and interdependencies in the transaction nor the competencies to execute a cost-effective outcome on their own. That is why navigation has become so critical. We need to help patients choose and use their health services more effectively so we can get consistently good, cost-effective outcomes.

Nurse navigation programs have exhibited benefits to key performance metrics including cutting costs and saving lives, as well as reducing length of stay. They also provide an experience benefit by providing a “personal touch.” But are they scalable and sustainable? Some leading institutions estimate patient-to-navigator ratios of between 250:1 to 400:1 depending on the care setting.

However, ratios have limits. As patient volumes grow and loads increase, nurse coordinators are bound to become less efficient and effective. Highly-trained personnel are hard to find and resources are already constrained, so will there be enough navigators to go around?

A smarter patient navigation strategy would focus your nurse resources on the patients who need and would benefit from the hand-holding, while providing “light navigation” through technology to patients that can act as their own co-pilots on the journeys to better health. In every other industry some amount of consumer DIY offsets the some of the load for a navigator. Examples like Esurance, TurboTax, For Sale By Owner real estate, and even new “choose your own” streaming pay-TV models like HBO Go have all created consumer-directed options for those of us that are comfortable or prefer to take control of these processes on our terms and time.